Dental Assessment

The mouth is the first segment of the digestive system and an airway for the respiratory system. It also contains taste buds and aids in speech production. The oral cavity is a short passage bordered by the lips, hard palate, soft palate, cheeks, and tongue.

The oral cavity includes the tongue, 32 teeth, gums, the uvula, and openings for three pairs of salivary glands the parotid, submandibular, and sublingual glands. The pharynx is the area behind the mouth and nose. The oropharynx is separated from the mouth by folds of tissue on each side, which are the anterior tonsil pillars. Behind these folds are the tonsils. These masses of lymphoid tissue enlarge until puberty and then involute. The naso-pharynx is continuous with the oropharynx, although it is above the oropharynx and behind the nasal cavity. It contains the pharyngeal tonsils or adenoids. By age 21/2, children normally have 20 deciduous (or temporary) teeth. These teeth are lost between ages 6 and 12 and replaced by permanent teeth.

Establishment of a dental home during infancy provides an opportunity to make a meaningful impact on the oral and general health of a patient. Early dental assessment assists in the prevention of dental disease and helps to optimize oral health over a lifetime. Furthermore, implementing early dental visits is a practice builder not only by providing a new patient source, but through retention of patients by encouraging lifelong care.

Although it was previously recommended that the first dental visit should be scheduled for age three unless a pediatrician recommended an earlier assessment, dental disease can arise much earlier. Eight per cent of children aged two have at least one decayed or filled tooth and over 40 per cent of children are affected by caries by the age of five. Early childhood caries (ECC) is a disease that when severe can affect growth, cause pain and infection and have lasting detrimental effects on the quality of life of patients and parents.2 In these cases, a dental visit at age three is often too late for prevention and the interventions required to treat ECC are both expensive and invasive.

The American Dental Association (ADA) recommends that the first dental visit take place within six months of eruption of the first tooth or by one year of age.The timing of this visit not only allows an opportunity for screening for dental caries, but also for preventive counseling and anticipatory guidance with regard to oral hygiene techniques, diet, fluoride exposure, non-nutritive sucking habits and injury prevention. Though the need for an early examination has been advocated, the protocol is not routinely practiced because parents are largely unaware of it and many dentists have limited experience or interest in performing an infant oral exam. The establishment of the dental home during infancy consists of two components: the history and physical examination followed by caries risk assessment and preventive counseling.

Medical and dental history

Taking maternal and infant medical/dental histories is a good opportunity to develop rapport with parents and to learn about their dental knowledge and expectations. Pertinent questions should assess demographics, medical history including complications during pregnancy or delivery, and the child’s medical conditions including allergies, medications, hospital stays and immunization status. In addition, a dental history should include oral home care routine, diet and presence of oral habits, history of dental trauma, fluoride use and prior dental visits. The dentist may also address specific concerns of the parent at this time.

Oral examination

A convenient and safe way to accomplish the physical examination is in the knee-to-knee position (Fig 1). The parent is instructed to sit sideways on the dental chair facing the dentist, who sits in the operator chair knee-to-knee with the parent. The infant is positioned on the parent’s lap facing the parent, with one leg wrapped around each side of the parent. This allows the parent to use his/her elbows to restrain the child’s legs, while having his/her hands available to hold the child’s hands. The child’s head is lowered on to a pillow on the operator’s lap for the examination. This position offers the dentist good stability of the child’s head, while the parent is responsible for the arms and legs. It is important to note that proper stability of both head and body is necessary to carry out a safe oral examination on an infant, and the parent must be aware of his/her role for this to occur.

Before beginning the examination it is important to counsel the parents that the child will likely cry and to reassure them that this is expected and normal. In fact, if the baby does cry, his/her open mouth will facilitate the intraoral examination. If the child will not open his/her mouth, a finger can be placed high and posterior to the most posterior tooth in the lateral pterygoid region to facilitate a jaw-opening reflex. The dentist should thoroughly assess the infant’s overall growth and development, extra-oral tissues and intra-oral soft tissues and teeth. Presence of plaque, gingivitis, decalcifications or white spot lesions, as well as any carious lesions or evidence of trauma should be noted.